胸椎旁连续输注亚甲蓝神经阻滞治疗胸段带状疱疹后神经痛的疗效观察

CLINICAL EFFECTS OF METHYLTHIONINE CHLORIDE CONTINUOUS THORACIC PARAVERTEBRAL BLOCK IN POSTHERPETIC NEURALGIA

摘要:

目的：研究亚甲蓝（methylene blue，MB）胸椎旁连续输注对胸段带状疱疹后神经痛（postherpetic neuralgia，PHN）的治疗效果。 方法：根据给药不同，将90例胸段带状疱疹后神经痛患者随机均分为亚甲蓝组、神经妥乐平（neurotropin，NTP）组和联合组。患者入院后予普瑞巴林75mg口服7天后行基线评估，予受累神经节段椎旁置管连续给药。分别监测三组患者治疗后1周、1月、3月、6月的数字疼痛评分法（NRS）、失眠严重程度指数（ISI）、健康问卷抑郁障碍量表（PHQ-9），并对疗效进行综合评价。结果:治疗后三组患者NRS评分、ISI评分、PHQ-9评分均明显下降（P<0.05），联合组、MB组下降幅度均高于NTP组（P<0.05），MB组与联合组组间无明显差异。结论：胸椎旁神经连续输注亚甲蓝可明显提高带状疱疹后神经痛的疗效、缓解患者的焦虑抑郁情绪、改善睡眠、提高患者的生活质量。

Abstract:

Objective: To investigate the effect of methylene blue (MB) continuous thoracic paravertebral nerve blocks on the treatment of postherpetic neuralgia (PHN). Methods: Ninety patients with thoracic postherpetic neuralgia were randomly equally into methylene blue（MB） group, neurotropin (NTP) group and combined group according to different medication. After admission, patients were asked to oral Pregabalin 75 mg for 7 days，then evaluate NRS score（Numerical rating scale）、ISI score（Insomnia Severity Index）and PHQ-9 score（The Patient Health Questionnaire-9）as baseline assesment，and then perform continuous thoracic paravertebral nerve blocks on affected nerve segment. NRS、ISI and PHQ-9 score were used for assessment of the patients after 1 week, 1, 3 , 6 months of treatment. Results: After treatment, the NRS，ISI and PHQ-9 score of the three groups were significantly decreased (P<0.05) compared with the baseline，and the combined group and MB group decreased significantly than NTP group (P<0.05). There was no significant difference between combined group and MB group. Conclusion: Continuous thoracic paravertebral nerve blocks with methylene blue could significantly improve the clinical effect of postherpetic neuralgia, relieve anxiety and depression，improve sleep and enhance life quality.